Provider Demographics
NPI:1952334450
Name:DIRECTOR OF FINANCE-COUNTY OF FAIRFAX VA
Entity Type:Organization
Organization Name:DIRECTOR OF FINANCE-COUNTY OF FAIRFAX VA
Other - Org Name:EARLY INTERVENTION SERVICES, FAIRFAX-FALLS CHURCH CSB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNTY EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-324-2536
Mailing Address - Street 1:12000 GOVERNMENT CENTER PKWY
Mailing Address - Street 2:SUITE 552
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22035-0001
Mailing Address - Country:US
Mailing Address - Phone:703-324-3360
Mailing Address - Fax:703-324-4573
Practice Address - Street 1:3750 BLENHEIM BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-1806
Practice Address - Country:US
Practice Address - Phone:703-246-7121
Practice Address - Fax:703-653-1385
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF FAIRFAX, VIRGINIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-08
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
VA113261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA191539OtherANTHEM
VA191541OtherANTHEM
VA004979737Medicaid
VA191540OtherANTHEM
VA293450OtherAMERIGROUP
VA113512OtherKAISER PERMANENTE
VA002193312002OtherUNITED HEALTHCARE
VA002193312002OtherUNITED HEALTHCARE